Mastectomy is a surgical procedure that removes the breast, most often due to breast cancer. The term “mastectomy” means the removal of the mammary gland.
The goal of this operation is to eliminate the primary tumour by removing the breast partially or completely. There are several types of mastectomy performed in Singapore that can be used for breast cancer treatment: total, partial, radical, and modified radical mastectomy. The type of surgery will be performed depends on the tumour size, the stage of breast cancer, the patient’s desire, and other factors that need to be discussed and taken into account before the upcoming treatment.
The removed breast can be restored with breast reconstruction operation. This procedure may be done in the meanwhile with the mastectomy or after that. Breast reconstruction achieves good aesthetic results. Both procedures, breast removal and reconstruction are available in Singapore.
When a mastectomy is required?
This operation is required for:
- cancer patients;
- Women with two or more tumour formations in different areas of the breast;
- Patients with recurrence after surgery or radiotherapy for breast cancer;
According to a study by the University of Michigan more and more women around the world are taking preventive healthcare and undergoing breast surgery, because of their fear of breast cancers. Researchers have found that this type of prevention of the illness is becoming “fashionable”. The intervention became especially popular when the actress Angelina Jolie underwent a mastectomy a few years ago.
Preventive mastectomy can be chosen by women who have a high genetic or familial risk of breast cancer. The operation reduces the risk of developing breast cancer by up to 90%.
However, experts expressed the opinion in the public space that such an operation without indications, just for fear of developing breast cancer, is not justified.
According to the World Health Organization, breast cancer kills more than 450,000 women each year, mostly in low-and middle-income countries. In Singapore, breast cancer is the most common type of cancer among women according to the Ministry of Health – accounting for 1 out of every 4 to 5 cancer cases. That’s why access to blood tests should become a priority as a life-saving and preventive action.
Types of mastectomy
Partial (breast-conserving) surgery
Breast-conserving surgery is the removal of tumour tissue along with part of the healthy tissue around it. Doctors in Singapore may recommend this operation to women with 1st or 2nd stage of breast cancer. The treatment is followed by radiation therapy to the rest of the breast tissue. By using powerful X-rays the therapy kills cancer cells and prevents them from spreading or recurring in the breast area.
Lumpectomy (wide excision) removes a small amount of normal tissue around the lump. If cancer cells are found later, the surgeon can remove more of the tissue.
Another type of partial mastectomy is called a quadrantectomy. For this procedure, the surgeon removes the tumour and the breast tissue around it.
After partial removal of the tumour, if cancer cells are found in the residual glandular tissue, may be necessary for another surgery to remove the whole breast.
This surgery removes the entire breast, including the nipple, areola, and larger part of the skin. The muscles under the chest wall and lymph nodes under the arm are preserved.
In some cases, breast cancer spreads to the axillary nodes which are under the arm. If that happens, those lymph nodes should be also removed.
Modified radical mastectomy
Modified radical breast surgery includes the removal of the whole breast and the lymph nodes under the arm. The underlying muscles of the chest wall are preserved. This kind of operation removes the mammary gland, including connective and adipose tissue as well as the lymph nodes in the axilla.
Today, fortunately, the removal of the pectoral muscles is necessary only when these are affected by the tumour, but this happens very rarely because in most cases, breast cancer is found before it grows into the muscles.
With this type of surgery, the whole breast is removed together with the underlying pectoral muscles and axillary nodes. The operation removes the whole mammary gland, lymph nodes, and muscles from the chest wall below the breast. Due to a radical mastectomy may occur a deformity of the chest. Radical surgery is rarely used in Singapore.
What type of surgery is right for you?
The choice of the operational approach depends on the following factors:
- Tumour size;
- The stage of the tumour;
- Tumour grade ( how much aggressive is it);
- Lymph node involvement;
- Age of the patient;
- General health.
How is mastectomy performed in Singapore?
The breast removal surgery is performed under general anaesthesia. Elliptical incisions are made, the tissues are carefully dissected and the pathologically altered ones are removed. A suture and a sterile bandage are applied to the site of the surgical wound. Additionally, drainage tubes are used. The purpose of these is to stop fluids, remove the blood and other substances from the operative area, and prevents the formation of large postoperative edema.
Regardless of the choice of surgery method, a piece of tumour and lymph node tissue is sent for pathohistological examination to confirm the diagnosis and look for metastases in the lymph node.
The operation normally takes about 2-3 hours and the patient should stay in the hospital for a few days. Depending on the type of mastectomy, after the skin incision, the breast tissue is sequentially separated from the skin and the underlying pectoral muscles.
Breast reconstruction can be performed during a mastectomy or at a later date. This normally depends on the physician’s recommendations and the patient’s desires. The procedure is a combination of plastic surgery techniques that create a new breast and improve a woman’s appearance and self-esteem. Some of the patients undergo complex surgery – breast removal and reconstruction, and others rebuild their breast after the healing process.
Risks and complications
Experts warn that some side effects, such as pain and tenderness in the operative area, may subsequently occur as a result of cutting nerve fibres during surgery. In some cases, fluid collections, a blood collection (hematoma), or a collection with clear contents are formed postoperatively at the site of the removed breast, which is resorbed spontaneously. Also, the healing process can be complicated by a wound infection or a rough skin scar, which may require re-operation.
How much does mastectomy cost in Singapore?
The price and all the costs for a mastectomy surgery in Singapore vary depending on many factors which you’ll have to go over with the doctors you speak with. The two major determining factors, however, are where you decide to have the surgery – public or private clinic.
In general, the procedure will cost less if you do it in a public hospital – the costs there are between $4000 and $7000. On the other and, the price range for mastectomy in a private clinic is between $12000 and $19000.
How to reconstruct the breast after cancer surgery?
When women realize that the breast needs to be removed, they are initially horrified. They are scared, thinking about how they will look like without a breast. This anxiety is completely understandable because the removal of the breast means radical body changes with negative consequences on a woman’s self-esteem and appearance. The solution is today’s breast reconstruction options that give a very good cosmetic result.
Whether and when to reconstruct the bust is a matter of discussion between the surgeon and the patient. The choice is made solely according to the woman’s wishes – whether to make an immediate reconstruction, during the operation or at a later stage, which will require a new operation. The goal of breast reconstruction is to make the removed breast look like a healthy one again.
The surgery can be performed by using some essential methods:
- By placing foreign artificial materials (implants) under the skin of the chest wall and chest muscles;
- Reconstruction with own tissue which is taken from another part of the body;
- Reconstruction by using other specific techniques.
Breast cancer is a major health problem with significant societal and social consequences for women around the world. Found it at an early-stage breast cancer can be successfully cured. Keep in mind that breast reduction does not lower that risk, as some people wrongly believe. It is important for every woman to make regular breast self-examination as well as screening mammography.